3.7 Mucolytics
For specialist prescribing only
Carbocysteine (capsules and liquid), an oral mucolytic drug, should not be used routinely in the management of stable COPD in accordance with current NICE recommendations. Treatment of stable COPD is aimed primarily at improving patient's quality of life and preventing exacerbations. Consequently it is difficult to see a routine place for mucolytic drugs in this context if the patient is already receiving inhaled corticosteroid/LABA combination. There may be a very limited role of these drugs in the very small number of patients in whom sputum expectoration is a major symptom. If there is no clear clinical improvement after 4 weeks then the oral mucolytic must be discontinued (BNF).
Dornase alfa (nebuliser solution) is used by specialists in cystic fibrosis patients, in accordance with the guidelines of the Cystic Fibrosis Trust.
Hypertonic Saline (7% nebuliser solution) used by specialists in cystic fibrosisis patients, in accordance with guidelines of the Cystic Fibrosis Trust
Acetylcysteine (granules) is occasionally used in cystic fibrosis patients to dissolve faecal masses in meconium ileus equivalent (distal intestinal obstruction). This is now only available on a named-patient basis.